Chapter 3

Several times, family members have asked a nurse to share personal prescriptions when they were in need of pain medication or antibiotics. Which type of rules or standards should govern the nurse's moral decision?

ethics

Which type of nursing diagnosis is a clinical judgment of a client's motivation and behavior to increase his or her well-being?

health promotion

A client with newly diagnosed diabetes requests information about how to give an injection. What is the best communication technique the nurse can use with the client?

informing about and demonstrating about the proper injection technique

Patient health education provided by the nurse

is an independent function of nursing practice.

Which type of nursing diagnosis identifies an existing condition that the client is experiencing?

problem-focused

Which type of nursing diagnosis identifies potential problems that may arise due to the client's disease, condition, or situation?

risk

A nurse using critical thinking interprets data and determines appropriate interventions. What factor will affect the nurse's ability to employ critical thinking with data interpretation?

the nurse's personal biases

A client presents to the acute care facility with several signs and symptoms. How will the nurse determine and prioritize the client's healthcare needs?

using a systematic method to plan and implement care to reach desired outcomes

A nurse saw a coworker steal drugs from a locked cabinet. The supervisor notices the missing drugs and has a good idea who is responsible for the theft. The supervisor asks if the nurse saw anything out of the ordinary. Which professional value reflects a nurse's duty to tell the truth?

veracity

The nurse prepares to administer medication to the patient. The patient states, "I would prefer not to take that medication until I speak with my physician." The nurse honors the patient's desire to make decisions, following which common ethical principle?

Autonomy

The use of patient restraints limits which ethical principle?

Autonomy

Which ethical principle is related to the duty to do good?

Beneficence

The LPN is collaborating with the RN in developing a plan of care for a new client. Which description of nursing roles best describes the LPN's contribution to the plan?

Data gathering, identification of client strengths, and assurance of client safety during the assessment phase

Skills needed in critical thinking include interpretation, analysis, evaluation, inference, explanation, and self-regulation. Which of the following describes interpretation?

Determine the significance of data that are gathered.

Which component of the nursing process deals with the identification of client problems?

Diagnosis

Which of the following is a true statement about critical thinking according to Alfaro-LeFevre (2010)?

It is guided by professional standards and codes of ethics.

The nurse is to administer a potassium supplement to the client. The nurse does not check the potassium level prior to administering the medication and later finds that the potassium level was at a critical high. What principle has this nurse violated?

Nonmaleficence

The RN develops an outcome standard of "client will ambulate with an assistive device 60 feet with assistance twice a day" for a client who had a hip replacement. What part of the nursing process is involved with this outcome statement?

Planning

The physician has ordered cimetidine for a client with gastric ulcers, and the nurse administers the first dose. The nurse's actions are noted in the medical record. This notation is an example of which aspect of implementing the plan of care?

documentation

A client, 50 years old, is admitted for treatment of a gastric tumor. The client asks the nurse, "Do you think I have cancer?" Which response by the nurse would be most therapeutic?

"You sound concerned about what the physicians will tell you."

What does the nurse determine is a moral problem rather than a moral dilemma?

A 32-year-old father of three with advanced cancer of the lungs asks that everything be done to prolong his life, even though his chemotherapy treatments are no longer effective.

The following nursing diagnoses are formulated with a client: constipation, acute pain, and caregiver role strain. During the planning phase of the nursing process, the nurse will prioritize the diagnoses in what order?

Acute pain, constipation, caregiver role strain

In determining goals for clients, the expected outcomes need to:

All of the responses are correct.

Which critical thinking skill involves identification of client problems indicated by data?

Analysis

The client has become confused and attempts to climb out of bed. What interventions will the nurse provide prior to applying restraints?

Arrange a schedule for staff to sit with the client.

The nurse is administering a medication to a client for the treatment of his constipation. The client states that he prefers not to take the medication today. The nurse respects the client's right and informs him if he needs it later, just let the nurse know. What professional value is the nurse displaying?

Autonomy

The nurse assesses a radial pulse rate of 48 beats per minute (bpm). Using critical thinking, what will be the best action for the nurse to take?

Check the client's previous pulse rates to validate the findings.

A nursing instructor is lecturing on ethics. To start the lecture, the instructor asks which issues students believe to be most common for nurses today. The students would choose which of the following? Choose all that apply.

Confidentiality End-of-life concerns Use of restraints

The nurse is caring for a terminally ill client in the intensive care unit that is on life support measures. The family members are opposed in their decision to take the client off of life support. What option does the nurse discuss with the nurse manager?

Contact the ethics committee for their input.

Analyzing information for patterns, maintaining a flexible attitude, and making decisions reflecting creativity are all what type of components necessary for nurses?

Critical thinking

The nurse obtains a client's oral temperature reading of 36.8°C. How should the nurse proceed?

Document the client's temperature result as obtained.

Which of the following is a cognitive or mental activity that nurses use in critical thinking?

Drawing on past clinical experiences and knowledge to explain what is happening

A client has designated her daughter as a person to make healthcare decisions for the client if he is not able to do so. What type of advance directive is this considered?

Durable power of attorney (DPOA) for healthcare

Which term is defined as a formal systematic study of moral beliefs?

Ethics

Healthcare providers use a problem-solving approach for ethical dilemmas. Which is the last step of the ethical decision-making model?

Evaluate the decision in terms of effects and results.

A client is to be discharged from an acute care facility after treatment for pneumonia. The nurse notes that the client's lungs are clear and denies shortness of breath. The nurse's actions reflect which step of the nursing process?

Evaluation

A client reports postoperative pain near the incision site on his abdomen. He describes the pain as constantly burning and rates it at an 8/10 using the pain scale. The nurse administers morphine sulfate 2 mg IVP as ordered. Ten minutes later the nurse documents that the client now rates his pain at a 3/10 using the pain scale. The nurse's documentation is an example of which part of the nursing process?

Evaluation

Which phase of the nursing process enables the nurse to compare the actual outcomes with the expected outcomes?

Evaluation

What statement does the nurse determine is a medical diagnosis rather than a nursing diagnosis?

Fever of unknown origin

A patient with a "Do Not Resuscitate" (DNR) order requires large doses of a narcotic for pain that rates a 10 on a 0-10 scale. After the patient requests pain medication, the nurse assesses a respiratory rate of 12 breaths per minute. What intervention by the nurse would be considered ethical?

Give the pain medication without fear of respiratory depression.

Which type of nursing diagnosis has a goal to increase well-being and enhance specific health behaviors?

Health promotion

Which element is involved in the planning phase of the nursing process?

Identify measurable outcomes

Which communication technique is helpful in health teaching about relevant aspects of a client's well-being and self-care?

Informing

Which of the following is a true statement about critical thinking in nursing?

It involves purposeful, outcome-directed thinking.

Which of the following is a true statement about a living will?

It states the client's wishes regarding healthcare if terminally ill.

A patient that has had a stroke is not able to eat without maximum assistance and has a nursing diagnosis of "Imbalanced nutrition, less than body requirements, related to inability to feed self." What would be an immediate nursing outcome for the patient to achieve?

Master the use of special eating utensils to feed self.

The nurse understands that one of the characteristics of critical thinking is flexibility. What can the nurse do to achieve this characteristic?

Modify priorities and adapt to change.

Based on the nurse's knowledge of the increased risk for bleeding in a client undergoing chemotherapy or radiation, which of the following interventions does the nurse need to include in the client's plan of care? Select all that apply.

Monitoring for signs of abnormal bleeding Monitoring the platelet count Instructing the client to use a soft toothbrush

Which situation would require the nurse to use critical thinking and decision-making skills in providing genetics-related nursing care?

Providing fertility counseling to a young family with a 2-year-old child with cystic fibrosis

Telling the truth (veracity) is one of the basic principles of North American culture. Three ethical dilemmas in clinical practice can directly conflict with this principle. Choose the three from the list below.

Revealing a diagnosis to people other than the client with the diagnosis Using placebos Not revealing a diagnosis to a client

A client has a nursing diagnosis of "Feeding self-care deficit related to right-sided weakness. Which of the following would be the most appropriate expected outcome for this client?

The client will demonstrate an ability to feed himself with a spoon at the morning meal.

A nurse chooses a quiet, private area to conduct an end-of-shift report to the oncoming nurse. Following this procedure is necessary because of what ethical problem in nursing?

The right of confidentiality is essential to protect each client's private information.

A client has been admitted to the hospital with a large sacral pressure ulcer. The physician orders the wound care protocol to be performed twice a day. What would be a statement on the plan of care that would address the implementation phase of the nursing process for this client?

Turn the client every 2 hours.

While collecting assessment information for a client in labor, the nurse learns that the client's surgical history includes an elective abortion. The client asks the nurse not to tell her spouse about the previous abortion. Faced with moral uncertainty, how should the nurse proceed?

Uphold the client's wishes, ensuring patient confidentiality

When an ethical decision is made based on the reasoning of the "greatest good for the greatest number," what theory is the nurse following?

Utilitarian theory

A hospital board of directors decides to close a pediatric burn treatment center (BTC) that annually admits 50 patients and to open a treatment center for terminally ill AIDS patients (with an expected annual admission of 200). This decision means that the nearest BTC for children is now 300 miles away. What example of ethical reasoning is this decision consistent with?

Utilitarianism

An advanced directive in which one person identifies another person to make health care decisions on his or her behalf is known as

a durable power of attorney for health care.

A client has been a resident of a long-term care facility for several years. The client's condition has deteriorated to the point that the client is now unable to eat. The physician has recommended surgical implantation of a feeding tube. The client's family has a legal document outlining the client's wishes in regard to measures such as this. What is this document?

advance directive

A client has just returned to the unit following abdominal surgery and is in significant pain. According to the nursing process, how frequently will the nurse perform assessments on this client?

as often as needed

Several days this week, a nurse takes time after work to read to a visually impaired client who has no family close by. This behavior demonstrates that ethical values:

concern the treatment of others.

The nurse is developing a client's care plan. What activity best exemplifies the assessment phase of the nursing process?

determines the client has a pulse rate of 88 bpm